KANGAROO MOTHER CARE -DETAILED

1. KANGAROO
MOTHER
CARE
DR. MAHESWARI JAIKUMAR
maheswarijaikumar2103@gmail.com

2. KANGAROO MOTHER CARE (KMC)
• Kangaroo mother care (KMC) is a
special way of caring for low
birth weight babies
• It improves health their babies

3. DEFINITION
Kangaroo mother care (KMC) refers
to the practice of providing
continuous skin-to-skin contact
between mother and baby,
exclusive breast milk feeding, and
early discharge from hospital

4. The baby is continuously kept
in skin to skin contact with
the mother and breast
feeding exclusively

5. HISTORY
• It was first presented by Rey and
Martinez,9 in Bogotá, Colombia,
where it was developed as an
alternative to inadequate and
insufficient incubator care for those
preterm newborn infants who had
overcome initial problems and
required only to feed and grow

6. WHO RECOMMENDATIONS
• Kangaroo mother care is
recommended for the routine
care of newborns weighing 2000
g or less at birth, and should be
initiated in health-care facilities
as soon as the newborns are
clinically stable

7. WHO RECOMMENDATIONS
• Intermittent Kangaroo mother
care, rather than conventional
care, is recommended for
newborns weighing 2000 g or
less at birth, if continuous
Kangaroo mother care is not
possible.

8. KEY FEATURES
• Early, continuous and prolonged
skin-to-skin contact between the
mother and the baby
• Exclusive breast feeding (ideally);
it is initiated in hospital and can be
continued at home

9. • Small babies can be discharged
early
• Mothers at home require
adequate support and follow-up

10. • It is a gentle, effective method
that avoids the agitation
routinely experienced in a busy
ward with preterm infants.

11. COMPONENTS OF KMC
• Three major components are:
• Kangaroo position: Skin to skin
contact
• Kangaroo nutrition: exclusive breast
feeding
• Kangaroo early discharge and
regular follow up

12. ADVANTAGES OF KMC
BENEFITS TO THE BABY
BENEFITS TO MOTHER
BENEFITS TO THE FAMILY
BENEFITS TO THE NATION

13. BENEFITS TO THE BABY
• Offers prolonged skin to skin
contact between the mothers
• KMC facilitates physiological
stability in baby

14. • KMC reduce apnea, oxygen
requirement and risk of
infection to the baby
• KMC help in early discharge of
babies from NICU

15. BENEFITS TO MOTHER
• KMC promote better mother
infant bonding
• Mother is less stressed during
KMC as the mother is more
actively involved in the care

16. BENEFITS TO THE FAMILY
• KMC is economical to the family
• KMC promotes early discharge of
baby
• KMC facilitates bonding between
the baby, mother and the family

17. BENEFITS TO THE NATION
• KMC decrease neonate and infant
mortality and morbidity
• KMC is simple easily applicable,
cost effective
• KMC results in healthier and
more intelligent babies

18. PROCEDURE OF KMC

19. PREPARING FOR KMC
• When the baby is ready for KMC,
mother and family members
should be counselled so that a
positive attitude is created for
KMC

20. • Mother should be provided
with a front open gown and
the baby is dressed with cap,
sock, nappy and front open
sleeveless shirt

21. KANGAROO POSITIONING
Baby should be placed the
mother’s breast in an upright
position and the baby’s head
should be turn to one side

22. • Hip should be flexed and
abduction in a frog position, the
arm should also be flexed
• Baby’s abdomen should be at the
level of mother’s epigastrium

23. FEEDING
• Mothers should
be explained
how to breast
feed while the
baby is in KMC
position

24. MONITORING
• Babies receiving KMC should be
monitored carefully especially in
the initial stages

25. MOTHER’S NEED DURING KMC
• Two or four-bed rooms of
reasonable size, where mothers
can stay day and night, live with
the baby, and share experience,
support and companionship; at
the same time they can have
private visits without disturbing
the others.

26. • The rooms should be equipped
with comfortable beds and
chairs for the mothers, if
possible adjustable or with
enough pillows to maintain an
upright or semi-recumbent
position for resting and sleeping.

27. • Curtains can help to ensure privacy
in a room with several beds.
The rooms should be kept warm for
small babies (22-24°C). Mothers
also need bathroom facilities with
tap water, soap and towels.

28. • They should have nutri- tious meals
and a place to eat with the baby in
KMC position.
• Another warm, smaller room
would be useful for individual work
with mothers, discussion of private
and confidential issues, and for
reassessing babies.

29. • The ward should have an open-
door policy for fathers and siblings.
• Daily shower or washing is
sufficient for maternal hygiene;
strict hand-washing should be
encouraged after using the toilet
and changing the baby.

30. • Mothers should have the
opportunity to change or wash
clothes during their stay at the
KMC facility.

31. • Recreational, educational and
even income-generating
activities can be organized for
mothers during KMC in order to
prevent or reduce the inevitable
frustrations of being away from
home and in an institution

32. • Noise levels should, however, be
kept low during such activities to
avoid disturbing the small
babies.

33. • Mothers should also be allowed
to move around freely during the
day at the institution and, if
possible, in the garden, provided
they respect the hospital
schedules for patient care and
regularly feed their babies

34. • Mothers should be discouraged
from smoking while providing
KMC and supported in their anti-
smoking efforts.
• Visitors should not be allowed to
smoke where there are small
babies, and the measure should
be reinforced if necessary

35. • During the long stay at the facility
visits by fathers and other
members of the family should be
allowed and encouraged.
• They can sometimes help the
mother, replacing her for skin-to-
skin contact with the baby so that
she can get some rest.

36. CLOTHING FOR THE MOTHER
• The mother can wear whatever she
finds comfortable and warm in the
ambient temperature, provided the
dress accommodates the baby, i.e.
keeps him firmly and comfortably in
contact with her skin.
• Special garments are not needed
unless traditional ones are too tight.

37. RESEARCH AND EXPERIENCE
• KMC is at least equivalent to
conventional care (incubators),
in terms of safety and thermal
protection, if measured by
mortality

38. • KMC, by facilitating
breastfeeding, offers noticeable
advantages in cases of severe
morbidity.
• KMC contributes to the
humanization of neonatal care
and to better bonding between
mother and baby in both low
and high-income countries.

39. • KMC is, in this respect, a modern
method of care in any setting,
even where expensive
technology and adequate care
are available.
• KMC has never been assessed in
the home setting.

40. THE SUPPORT BINDER
• This is the only special item
needed for KMC. It helps
mothers hold their babies safely
close to their chest

41. THE SUPPORT BINDER

42. • To begin with, use a soft piece of
fabric, about a meter square,
folded diagonally in two and
secured with a safe knot or
tucked up under the mother’s
armpit.

43. • Later a carrying pouch of
mother’s choice (Fig. next slide)
can replace this cloth

44. CARRYING POUCHES FOR KMC
BABIES

45. • All these options leave the mother
with both hands free and allow her
to move around easily while
carrying the baby skin- to-skin.
• Some institutions prefer to provide
their own type of pouch, shirt or
band.

46. BABY’S NEEDS
• When baby receives continuous
KMC, he does not need any more
clothing than an infant in
conventional care.

47. • If KMC is not continuous, the
baby can be placed in a warm
bed and covered with a blanket
between spells of KMC.

48. CLOTHING FOR THE BABY
• When the ambient temperature
is 22-24°C, the baby is carried in
kangaroo position naked, except
for the diaper, a warm hat and
socks (fig next slide)

49. CLOTHING FOR BABY

50. • When the temperature drops below
22°C, baby should wear a cotton,
sleeveless shirt, open at the front to
allow the face, chest, abdomen,
arms and legs to remain in skin-to-
skin contact with the mother’s chest
and abdomen.
• The mother then covers herself and
the baby with her usual dress.

51. OTHER EQUIPMENT AND
SUPPLIES
• A thermometer suitable for
measuring body temperature
down to 35°C; scales: ideally
neonatal scales with 10 g
intervals should be used

52. • Basic resuscitation equipment, and
oxygen where possible, should be
available where preterm babies are
cared for;
• Drugs for preventing and treating
frequent problems of preterm
newborn babies may be added
according to local protocols (Special
drugs are sometimes needed)

53. RECORD KEEPING
• Each mother-baby pair needs a
record sheet to note daily
observations, information about
feeding and weight, and
instructions for monitoring the
baby as well as specific
instructions for the mother.

54. • Accurate standard records are the
key to good individual care; accurate
standard indicators are the key to
sound programme evaluation.
• A register (logbook) contains basic
information on all infants and type
of care received, and provides
information for monitoring and
periodic programme evaluation

55. DISCHARGE AND HOME CARE
• Once the baby is feeding well,
maintaining stable body
temperature in KMC position
and gaining weight, mother and
baby can go home.

56. • Since most babies will still be
premature at the time of
discharge, regular follow-up by a
skilled professional close to
mother’s home must be ensured.
• Frequency of visits may vary
from daily at the beginning, to
weekly and monthly later.

57. • The better the follow-up, the
earlier mother and baby can be
discharged from the facility. As a
guide, services must plan at least
1 visit for every preterm week.
• Those visits can also be carried
out at home.

58. • Mothers also need free access to
health professionals for any type of
counselling and support related to
the care of their small babies.
• There should be at least one home
visit by a public health nurse to
assess home conditions, home
support and ability to travel for
follow-up visits.

59. • If possible, support groups in the
community should be involved in the
home (to provide social, psychological,
and domestic work support).
• Mothers with previous KMC
experience can be effective providers
of this kind of community assistance.

60. RECORDS TO BE MAINTAINED
–when KMC began (date, weight and
age);
–condition of the baby;
–details on duration and frequency of
skin-to-skin contact;
–whether the mother is hospitalized or
is coming from home;
–predominant feeding method;

61. –observations about lactation and feeding;
–daily weight gain;
–episodes of illness, other conditions or
complications;
–the drugs baby is receiving;
–details on discharge: condition of the
baby, maternal readiness, conditions at
home that make discharge possible; date,
age, weight and post-menstrual age at
discharge; feeding method and
instructions for follow-up (where, when
and how frequently).

62. • Mother should be given a discharge
letter summarizing the course of
hospitalization and instructions for
home care, medication and follow-
up.
• It is also necessary to record
whether the baby was transferred
to another institution or died.

63. • The follow-up record should
contain, besides the usual data on
the baby, the following information:
–when the baby was first seen (date,
age, weight and post-menstrual age);
–feeding method;
–daily duration of skin-to-skin contact;
–any concerns mother may have;

64. –whether baby has to be or has been
readmitted to hospital;
–when mother stopped skin-to-skin
contact (date, age of the baby, weight,
post-menstrual age, reasons for
stopping and feeding method at
weaning);
–other important remarks.

65. • If the follow-up care is provided at
the facility where the baby was
hospitalized, the hospital record and
the follow-up record should be a
single document. If this cannot be
done, the two records must be
linked by an identification number.

66. SAMPLE RECORD -KMC
Date of visit 1 2 3 3 4
Age
Weight
weight gain
Feeding
method
Average daily
duration of
skin-to-skin
contact
Complaints
Readmission
to hospital
Weaned Date
Age (in days)
Post-menstrual age
Weight
Reasons for weaning and other comments

67. THANK YOU